NUR241: Health Alterations Case Study Assignment Help
Question
NUR241: This is a Health alterations-based nursing assignment for the University of Sunshine Coast in which the students are required to respond to a case study using their knowledge of pathophysiology and processes of disease. The student is supposed to demonstrate the application of evidence-based literature, to the delivery of patient-centered care for a patient with a particular medical condition. Additionally, the healthcare professional standards also need to be evaluated.
Solution
The solution for this assignment incorporates a response-based essay on a case study of Ischemic stroke. This response includes the pathophysiology of the health change, evidence-based nursing care, and the use of professional health care standards for providing patient-centered care.
The case study demands the students to imagine themselves in the role of a registered nurse working in an inpatient medical ward. An elderly patient named Arthur Smith was brought in by ambulance to the emergency room eighteen hours ago with altered feeling, dysphagia, hypertension, hemianopia, and right-sided hemiparesis. The patient’s medical and social history has been recorded.
The solution is divided into the following sections: Introduction, Pathophysiology of the patient, Nursing Interventions, Discharge Plan, and Conclusion.
Introduction
Firstly, a brief introduction is provided to highlight the purpose of writing this case study response solution.
Stroke is the most common cause of disability after heart disease in Australia. Ischemic stroke occurs due to inadequate blood supply to the brain that can be due to thrombotic causes like atherosclerosis and embolic causes like atrial fibrillation and myocardial infarction (Béjot et al., 2016). Thrombotic strokes are the most common cause of stroke in elderly individuals, especially those with high cholesterol, atherosclerosis or diabetes. Most thrombotic strokes are associated with hypertension or diabetes, both of which accelerate atherosclerosis (van Rooy & Pretorius, 2014).
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Pathophysiology
The pathophysiological alterations that take place in the body in connection with the particular changes in the patient’s health.
Mr Smith’s history of TIA and atherosclerosis is indicative of thrombotic stroke in Mr Smith’s case. Ischemic middle cerebral artery (MCA) stroke occurs due to the occlusion of middle cerebral artery due to thrombus formation. This is further accentuated by Mr Smith’s history of atherosclerosis and TIA as atherosclerosis causes narrowing down of of blood vessels causing poor blood perfusion to the brain and patients with previous history of TIA are also highly susceptible to ischemic stroke (Amarenco et al., 2018). MCA supplies a major part of the cortex of the brain hence occlusion of MCA may elicit a variety of functional and neurological deficits including hemiparesis, hemianopia, dysphagia. There is a cascade of reactions that takes place during ischemic stroke. Firstly, occlusion of MCA increases the blood pressure on the vessel walls thereby inducing a state of transient hypertension. Along with this poor perfusion to the brain causes embolism and cell necrosis which leads to breakdown of cell membrane and the cellular materials escapes out of the cell causing neuronal damage and altered sensation.
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Nursing Interventions
In this section, our experts have proposed certain nursing interventions to provide patient-centered care along with accumulating professional requirements for the practice that affect how medical treatment is delivered.
Nurses must continuously monitor his BP every two hours until his BP is 120/80 (Khan et al., 2017). Mr Smith had high blood pressure which can be due his body’s attempts to increase cerebral blood flow but elevation in BP is also indicative of increased intracranial pressure (ICP). Increased ICP in Mr Smith’s case can precipitate seizures, cognitive impairment and may also lead to loss of vision due to inflammation of the optic nerve (Drummond, 2019). This is also supported by Standard 4.2 of NMBA (2016) which suggests using assessment techniques to inform practice and Standard 8.4 of NSQHS (2017) which helps recognise acute deterioration through monitoring. Hence, it is crucial to assess Mr Smith’s BP to minimize potential risks. Secondly, Standard 5.28c of NSQHS (2017) states that malnutrition increases the risk of mortality and increased hospital stays hence, RN must place Mr Smith on NBM in addition to IV therapy until his dysphagia is resolved to ensure adequate nutrition and fluid intake. It is necessary for the RN to closely monitor fluid and nutrition intake as it can lead to dehydration and malnutrition thereby delaying Mr Smith’s recovery. Next, RN must also position Mr Smith in an upright position, with the head elevated to reduce the risk of aspiration due to dysphagia and maintain airway patency every two hours. This is supported by the Standard 6.1 of NMBA (2016) which suggests providing safe and quality nursing practice to achieve outcomes as per the nursing needs of the patient. Deep breathing exercises must also be incorporated in order to resolve dysphagia and reduce the risk of aspiration (Phan et al., 2019).
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Discharge Plan
The following section presents a customized discharge plan with needs and ongoing goals for the patient in the case study created by our nursing subject matter experts.
According to Quality statement 7 for Acute Stroke Clinical Care, NSQHS, (2017), the patient must have an individualized discharge plan that includes rehabilitation goals and lifestyle modifications required at home. Hence, rehabilitation goals for Mr Smith’s dysphagia and hemiparesis must be developed by RN in collaboration with the specialists by using assessment tools like Australian Stroke Data Tool (AuSDaT). This is also supported by Standard 4.2 (NMBA, 2016). Firstly, RN must work along with physiotherapist, occupational therapist and speech therapist to improve Mr Smith’s ability to swallow and maintain adequate nutrition and hydration (Standard 4.3, NMBA, 2016). This will involve swallow exercises like Mendelsohn maneuver, effortful swallow and chin tuck exercises 5 times per day for 4 weeks to increase ability to tolerate regular diet without the sign of aspiration by 4 weeks (Choy et al., 2023). Additionally, Diet modification will also be done by texture modification and serving food in thick liquid consistency to avoid aspiration and nutritional supplements to prevent nutrition deficit (O’Keeffe, 2018). Secondly, rehabilitation goals for Mr Smith will include improving motor function, balance and coordination and decrease dependency in activities of daily living (ADLs).
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Conclusion
A short Conclusion is presented to outline all the significant arguments presents in this response assignment.
This report analysed the case study of Mr Smith who was diagnosed with an ischemic left MCA stroke. The stroke was likely precipitated by his previous history of TIA and atherosclerosis. Also, since left side MCA was occluded during stroke, it presented as a right side hemiparesis and hemianopia on the right side of both eyes. Further, the paralysis of nerves and muscles due to hemiparesis presented as dysphagia and aphasia. Nursing care included continuous monitoring of BP, NBM until dysphagia is resolved, deep breathing exercises to avoid aspiration due to dysphagia and early mobilization to reduce risk of DVT due to hemiparesis along with fall risk assessment by FRAT and incorporating gestures and native language during communication.
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